The Presbyterian Church (U.S.A.) Board of Pensions continues to adjust the Medical Plan covering church employees in response to passage of the Patient Protection and Affordable Care Act (PPACA) by the U.S. Congress in March of this year.

While the PPACA doesn't take full effect until 2014, the board has made changes in the PC(USA)'s Medical Plan at each of its meetings since the legislation was adopted.

At its meeting here last month, the board agreed — in keeping with President Obama's pledge that those who like their current medical coverage can retain it — to "grandfather" the denomination’s  traditional Medical Plan.

"After analyzing the requirements and implications of the new law, the Board and its directors concluded that grandfathering the Traditional Program (that is, leaving all current provisions basically intact), at least for the time being, is in the best interests of plan members and PC(USA) churches and employing organizations," the board said in its post-meeting statement.

Patricia Haines, the BOP's senior vice-president for benefits, told the board's Healthcare Committee that grandfathering will give it the opportunity "to figure out all the ins and outs" of the evolving legislation. She also said most political and healthcare experts also expect "some incremental changes to PPACA following the November elections and grandfathering gives us flexibility to wait, see and adjust accordingly."

Grandfathering does not apply to the Affiliated Benefits Program (ABP), which depends on flexibility to individually determine who is eligible for coverage and how much participants will contribute for their coverage.

Many of the legislation's provisions apply to all plans, including grandfathered ones, and so the board took the following actions, effective Jan. 1, 2011:

  • Eliminated the lifetime dollar maximum coverage and replaced it with a $3.5 million annual dollar maximum;
  • Amended the Medical Plan to comply with the PPACA provision that prohibits retroactive termination of benefits for any reason other than fraud, intentional misrepresentation of material fact or failure to pay dues;
  • Amended the Medical Plan to clarify its coverage of advanced reproductive technologies.

The board also unveiled a new vision/eye care benefit that enables Medical Plan members and their dependents to go for a routine annual eye examination and pay only a $25 copay, provided they see a Vision Service Plan (VSP) participating optometrist or ophthalmologist. The Medical Plan will cover the remaining cost of the exam.

The cost of prescribed glasses or contact lenses is not covered under this benefit, although discounts on these items will be available from VSP, the largest network of private eye doctors in the country with more than 39,000 specialists, mostly optometrists.

"The directors of the Board of Pensions approved this additional benefit because eye care is an important aspect of overall health management," its statement said. A comprehensive vision examination can lead to the early detection of serious eye conditions such as glaucoma, macular degeneration, and diabetic retinopathy. Eye examinations can also reveal early signs of other chronic health conditions like diabetes, pre-diabetes, hypertension, and high cholesterol — highly prevalent conditions in the U.S. population today. Early detection of these conditions clearly is in the best interest of Benefits Plan members; moreover, it may help reduce healthcare costs for the plan, for members, and, potentially, for employing organizations, as well."

In other actions, the board:

  • Approved Christmas gifts of $250 for each single person and $500 for married couples who are currently receiving housing and/or income supplements through the board’s Assistance Program;
  • Increased Medicare Supplement Plan dues from $199 to $205 per month for traditional program participants, from $125 to $129 per month for limited income members and from $279 to $287 per month for Affiliated Benefits Program participants, effective Jan. 1, 2011;
  • Increased Medical Continuation Program dues 6.9 percent — from $332 to $355 per month for those enrolled prior to 1987 and from $564 to $603 per month for those enrolled after 1986, effective Jan. 1, 2011;
  • Received a report that the BOP’s balanced investment portfolio had a 6.7 percent return for the nine months ended Sept. 30, 2010. The Pension Plan (114 percent of potential liabilities and the Death and Disability Plan (179 percent of liabilities) both remain "fully funded," said Michael Fallon, the board's vice-president for finance.

For the fourth consecutive year, Medical Plan dues will remain unchanged in 2011 at 19.5 percent of "effective salary."  But Medical Plan actuary John Cookson said that if current trends continue, the plan's contingency reserve is projected to dip below the 20 percent mark the BOP has targeted as its minimum contingency reserve level. Thus, a Medical Plan dues increase is likely in 2012.